CONDITIONS

Prostate Cancer

What Is Prostate Cancer

To better understand prostate cancer, it helps to understand what the prostate is. The prostate is a gland found only in males, and is located in front of the rectum and below the urinary bladder. The size of the prostate varies with age. In younger men, it is about the size of a walnut, but it can be much larger in older men. The job of the prostate is to produce semen—the fluid that nourishes and protects sperm. Prostate cancer is cancer in a small walnut-sized gland called the prostate.

Prostate cancer is one of the most common cancers in men, affecting about 1 in 7 men at some time in their lives. Prostate cancer is rare before age 40, and most common in men over 65. More than 2 million men in the United States are prostate cancer survivors.

Prostate cancer tends to grow slowly and can usually be treated successfully, but it can be very serious if it is not found before it spreads.

What Causes Prostate Cancer

No one knows for sure what causes prostate cancer. Science has found some risk factors that may make the disease more likely.

Risk Factors For Prostate Cancer

Your age is the biggest risk factor for prostate cancer. Prostate cancer is rare in men under 40. Three out of five cases are diagnosed in men aged 65 or older.

 Your ethnicity is another key factor. Prostate cancer is most common in African American and Afro-Caribbean men, and less common in Asian American and Latino men. Prostate cancer is more common in North America, Europe, Australia, and the Caribbean, and less common in Asia, Africa, and South and Central America. This disparity in prostate cancer incidence may be secondary to differences in diet, lifestyles, life expectancies, and reporting/diagnoses of the condition itself. 

Other risk factors for prostate cancer include:

  • Genes and family history
  • Obesity and a high-fat diet

Diagnosing Prostate Cancer

When you visit your doctor to talk about prostate cancer symptoms, your doctor will ask questions about your symptoms and perform tests such as:

  • A digital rectal exam–that is, feeling the size of your prostate with a gloved finger
  • A prostate-specific antigen (PSA) blood test

If these tests find a problem, your doctor may follow up with an ultrasound or by taking a sample from your prostate for biopsy.

If prostate cancer is found, our doctor will have the cells examined to find out how aggressive the cancer is. The scale used is called the Gleason score, and it ranges from 2 for non-aggressive cancer to 10 if the cancer is highly aggressive. Your doctor may also check the surrounding areas through bone scan, ultrasound, or other imaging tests to find out if the cancer has spread.

Symptoms of Prostate Cancer

Prostate cancer can go undetected for a long time. When symptoms do arise, they may include: 

  • Difficulty urinating, or weak stream
  • Blood in the urine or semen
  • Pain or discomfort in or around the pelvic area, including bone or lower back pain
  • Erectile dysfunction

Prognosis

Prostate cancer is usually treatable, but it can be lethal if it is caught too late. After lung cancer, prostate cancer is the next most common cause of cancer death in men, killing one out of every 36 men–but most men with prostate cancer survive.

Survival rates for prostate cancer are almost 100% at 5 years after diagnosis, 99% at 10 years, and 94% at 15. However, if the cancer spreads to bones, other organs, or distant lymph nodes, 5-year survival drops to 28%.

Living With Prostate Cancer

Because prostate cancer often grows slowly and is diagnosed at an older age, many men with prostate cancer are not treated right away, and some may never need treatment. If your cancer is not too advanced, you may only need active surveillance with regular testing to monitor the progression of the disease.

Many of the treatments run the risk of side effects such as erectile dysfunction or various urinary problems. However, these symptoms often resolve in their own over time.

For most men it can take weeks or months to regain full bladder control and months or even years to regain erectile function. If erectile dysfunction is a problem for you, it can be treated with medicines such as Viagra (sildenafil), a vacuum pump, or, if it is a long-term problem, with a penile implant.

Screening

Not all doctors recommend screening for prostate cancer. Some medical organizations raise concerns that screening could lead to unnecessary treatments and other problems. According to the American Cancer Society, screening for prostate cancer is a decision you should make for yourself after speaking with your doctor.

Screening tests for prostate cancer include: 

  • A digital rectal exam. In this test, your doctor inserts a gloved, lubricated finger inside your rectum to feel your prostate
  • A blood test to check PSA levels in your bloodstream

If either of these screening tests finds a problem, then other tests are needed to confirm the diagnosis and find out how serious it is.

Prevention

There are steps you can take that may help to lower your risk of prostate cancer:

  • Eat healthy foods. Stay away from excess fats, and eat lots of fruits, vegetables, and whole grains. Be sure to get your vitamins from the source, because there’s not much evidence showing that supplements help the same way fruits and vegetables do.
  • Exercise most days. Some studies suggest that exercise reduces prostate cancer risk. And diet and exercise together can help prevent obesity–a known risk factor for prostate cancer.

Discuss your risk with your doctor. If you are at high risk because of genetics, family history, or other reasons, your doctor may suggest using medicines such as Avodart (dutasteride) or Propecia (finasteride) to lower your risk. However, these medicines should be used cautiously, as they may make prostate cancer more aggressive if it does occur.

Common Treatment

The best treatment for prostate cancer depends on how fast the cancer is growing, how far it has already spread, your overall health, and your personal preference. Many men with prostate cancer won’t need treatment right away, and some may never need it. 

Common treatments for prostate cancer include:

  • Radiation therapy. This can be external-beam radiation, given 5 days a week for several weeks, or brachiotherapy, in which a doctor uses ultrasound to guide small radioactive “seeds” into your prostate with a needle. Side effects of radiation may include frequent urination or bowel movements, pain when using the toilet, or erectile dysfunction.
  • Hormone-blocking therapy. Your doctor may prescribe a hormone agonist such as Lupron (leuprolide) to stop your body from making testosterone, or an anti-androgen such as Casodex (flutamide) to keep the testosterone from reaching cancer cells. Hormone-blocking therapy can slow tumor growth and is often used before or after radiation therapy to increase the chance of success. Side effects may include erectile dysfunction or loss of sex drive, bone loss, hot flashes, and weight gain.
  • Radical prostatectomy, or surgery to remove the prostate. The most common side effects with this procedure are urinary incontinence and erectile dysfunction. Usually you will regain control of your urinary function gradually within several weeks or months. Full erectile function may take up to 2 years to return. If these problems persist, there are other treatments available.

For more difficult cases, your doctor may also recommend chemotherapy, immunotherapy, or clinical trials involving heating or freezing the cancer cells.

Complementary and Alternative Treatment

There is no alternative treatment that can cure prostate cancer, but complementary treatments may help you cope with the disease or the side effects of treatment. Some complementary treatments include: 

  • Meditation or yoga
  • Dance or movement therapy
  • Relaxation techniques
  • Art or music therapy.

Care Guide

It is a good idea to learn about your cancer and its treatment, so that you can make the best decisions. Talk openly about your feelings with friends, family, and other cancer survivors, and take good care of yourself overall. This includes getting enough sleep and exercise, and eating a healthy diet full of fruits and vegetables. 

Prostate cancer and its treatments may affect your erectile function as well, but you should not allow this to get in the way of your need for intimacy with your partner. There are many other ways to express your feelings. If erectile dysfunction persists, there are treatments available.

When To Contact A Doctor

You should talk to your doctor about prostate cancer screening and whether it is a good idea for you. You should also make an appointment if you have troubling symptoms such as pain, difficulty urinating, or blood in your urine or semen.

Questions For Your Doctor

There are several ways to find a doctor to treat your prostate cancer. Talk to your family doctor, or try one of these sites:

Questions For A Doctor

When you go to see your doctor, it’s good to have a list of the questions you’d like to have answered. 1Take a moment to write down some of the things you want to know. Your questions for your doctor might include some of these:

  • Do I have prostate cancer?
  • What type of prostate cancer do I have?
  • Has the cancer spread beyond my prostate?
  • What are my treatment options?
  • Is there one course of action you recommend?
  • What side effects should I worry about?
  • What is the chance that treatment will cure my cancer?
  • Is there anything else I should know about prostate cancer?

Resources

Some other useful resources to help you learn about prostate cancer can be found at:

American Cancer Society

National Cancer Institute

Prostate Cancer Foundation